Healthcare Provider Details

I. General information

NPI: 1720230675
Provider Name (Legal Business Name): PRETRESCIA MARIE GRUBBS DNP, ACNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. PRETRESCIA MARIE WALKER

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHI-ST. VINCENT INFIRMARY-HOSPITALIST GROUP 2 SAINT VINCENT CIRCLE
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

2 SAINT VINCENT CIR
LITTLE ROCK AR
72205-5423
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-3368
  • Fax: 501-552-4555
Mailing address:
  • Phone: 501-552-3368
  • Fax: 501-552-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberAO1609
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA01609
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: